A SILENT EPIDEMIC

Aging addicts are among our most vulnerable populations—yet we never talk about them

In June of last year, I stopped to visit my 65-year-old mother and her 58-year-old husband in the sun-bleached hills of Sonoma County, where I was giving a reading from my new book. My stepfather, an exuberant talker who usually defaults to a cheerful facade, greeted me with trembling hands and a slurring, teary ramble about the job from which he’d been unceremoniously laid off six months prior. If I’d only just met him, I’d have thought I was looking at the early phases of dementia or maybe Parkinson’s. Instead, I suspected that his symptoms were the result of pills–most likely prescribed by a doctor who had minimized or misunderstood the implications of his long history of addiction. I curled into denial and went back to my own life, two hours away.

Several months later, after a series of confusing, turmoil-filled texts from my mother, I visited again. This time, it was my mother who seemed to be in a mysterious decline. She drifted off mid-conversation, lids at half-mast. One evening, I had to rescue a melting pint of ice cream as it oozed down her legs. Again, it would have been easy to confuse these behaviors with age-related or neurological symptoms. But I knew better. Though my mother and stepfather both spent years committed to their sobriety, I recognized the signs of their addictive behaviors, and I knew they were attempting to cope with legitimate pain related to loss of work, painful and ineffective surgeries, and big emotional losses. Though my mother and stepfather both spent years committed to their sobriety, I recognized the signs of their addictive behaviors. 

I was overcome with conflicting emotions. We live in a culture of deeply mixed messages and lingering stigma about addiction. It’s okay to share “weekend wino” memes with your girlfriends, but the addict who can’t keep up daily tasks or dies of her disease is vilified as morally bankrupt. Aging addicts are among our most vulnerable populations. And yet it is one we almost never hear about, let alone try to understand.

The National Institute of Health has shown “without question that addiction is a chronic, medical disease of the brain,” Dr. Harold Urschel, chief medical strategist for Enterhealth addiction treatment centers and author of Healing the Addicted Brain, tells Quartz. Alcohol and the other controlled substances are “neurotoxins that cause brain injury to certain people.” More than a few studies have shown that drugs and alcohol change the neural structure of the brain and have genetic underpinnings that predispose some people to addiction more than others. More research has found alcohol influences specific neural pathways leading to addiction.

Urschel compares addiction to the neurodegenerative disease Alzheimer’s. Both impair the brain’s frontal lobes—particularly the limbic system, which alerts you to a problem and urges you to take action. Unlike Alzheimer’s, however, Urschel says most addicts can recover their brain function within four to 18 months of stopping substance abuse.

 We live in a culture of deeply mixed messages and lingering stigma about addiction.  This means that while the problem is indeed dire, the future for addicts need not be hopeless.

“Alcoholism is the third leading cause of death in the world,” he says. “It’s important for us to throw the whole kitchen sink at this. Most people just using the AA approach have a 25% success rate, but when you treat addiction appropriately with medication, nutrition and stress management, we see a 75% success rate, and that doesn’t exclude AA. Trying to treat addiction with just AA is like treating diabetes with just a support group where you sit around talking. It won’t treat the chronic illness.”

So what’s the problem? In a word: stigma. According to a 2008 study in The Gerontologist there is a “commonly held view that willpower and personal strength alone is needed to control addiction.” This myth is perpetuated because addicts often engage in regretful or even criminal behavior once under they are under the influence.

Yet medications exist that are proven to reduce cravings and even interfere with the brain’s ability to produce the dopamine response that creates a high. Vivitrol is a once-a-month shot that decreases alcohol cravings and blocks a person’s ability to get drunk. Naltrexone, which can be taken while a person is still using, reduces alcohol cravings and prevents a person from feeling high or drunk. Suboxone does the same for opiates.

 “Alcoholism is the third leading cause of death in the world. It’s important for us to throw the whole kitchen sink at this.” These medications are useless, however, if they stay on pharmacy shelves. And if addicts are struggling with unsuccessful treatment and lingering shame, they may feel their only option is to drive their loved ones way.

This response only makes the problem worse: research shows that loneliness can kill us.“The magnitude of the association between social relationships and mortality has now been established,” according to a 2008 meta-analysis study in PLOS Medicine, which pulled data from 308,849 individuals. The researchers concluded that the benefit of social interaction for lonely people “is comparable with quitting smoking and it exceeds many well-known risk factors for mortality.”

“Loneliness will make you sicker faster and exacerbates all the bad things about being by yourself,” agrees Kori Novak, a gerontologist and researcher at Oxford University.

Older adults are especially vulnerable to loneliness and addiction. “Being an elderly addict is tough, because they often give up on themselves,” Novak tells Quartz. “They think ‘I’m too old to get better’ and if there is nobody there to push or support or encourage them, they can have a downward spiral.”

What’s more, symptoms of addiction often masquerade as other medical problems. The Research Institute on Addictions calls substance abuse in older adults “a hidden problem.”

“In families that are struggling with these issues in their elderly parents or grandparents, you need to take these substances [out of the equation],” says Urschel. This is why he argues against letting elderly people drink more than one drink once or twice per week, if at all.

 “People don’t like to look at elder addiction because they don’t like to talk about getting old.” “People don’t like to look at elder addiction because they don’t like to talk about getting old,” says Novak. “Let’s face it, getting old is not for the faint-hearted.”

Indeed, it wasn’t until my cousin who lives in New York made a rare visit this past December that I was forced out of my denial. I realized that my stepfather’s mental health was in a precarious state. That was also threatening my mother’s ability to rest and function at her new job–their one source of income. My cousin and I took on practical tasks like helping my stepfather file for retirement and obtain health care, and nudged both my parents back toward their recovery communities. But I firmly believe the sheer act of showing up, and shining the light of awareness into their isolation, was the key.

In that regard, the social aspect of 12-step groups may be crucial for aging addicts.“Community and a sense of belonging is tremendously important,” Deni Carise, chief clinical officer at Recovery Centers of America, tells Quartz. She admits, however, that treatment programs need to be modified for older adults, whose needs differ from younger addicts.

Novak says she sympathizes with the frustrations experienced by relatives of aging addicts. But she also exhorts relatives: “If you’re the loved one of an addict, just don’t leave them. No one should age and die alone.”

Follow Jordan on Twitter at @jordanrosenfeld. We welcome your comments at ideas@qz.com.

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